Abstract
The prevalence of hypertension is high and increasing worldwide. Drug therapy is effective, but for both “prehypertensive” and treated hypertensive patients, lifestyle changes are also important. Dietary modification is a key part of these changes, although skepticism about the role of diet in determining blood pressure has slowed implementation of the available guidelines. However, there is now a large body of evidence supporting a role for dietary salt, potassium, alcohol, and body mass in determining blood pressure. Studies such as PREMIER have shown that salt restriction (<6 g/d), alcohol moderation (<2U/d in men and <1U/d in women), weight loss (if BMI>25), exercise, and a DASH (Dietary Approaches to Stop Hypertension) diet (supplying 20–30 mmol/d of potassium) can achieve decreases in systolic blood pressure of approximately 10 to 15 mm Hg when applied together. Of the dietary changes, salt intake remains the most amenable to change. But we must further reduce salt in processed food if it is to be part of a wider strategy to lower blood pressure in the general population. Nevertheless, the message to patients must be that dietary changes made within a concerted alteration in lifestyle can have a very significant impact on their blood pressure.
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References and Recommended Reading
Wang Y, Wang QJ: The prevalence of prehypertension and hypertension among US adults according to the new Joint National Committee Guidelines: new challenges of the old problem. Arch Intern Med 2004, 164:2126–2134.
Wolf-Maier K, Cooper RS, Banegas JR, et al.: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003, 289:2363–2369.
Kaplan NM, Opie LH: Controversies in hypertension. Lancet 2006, 367:168–176. Good and very up-to-date review of the issues affecting hypertension management.
Whelton PK, He J, Appel LJ, et al.: Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002, 288:1882–1888.
Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003, 289:2560–2571. The lastest JNC guidelines.
Williams B, Poulter NR, Brown MJ, et al.: British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 2004, 328:634–640. A UK perspective on hypertension management.
Appel LJ, Brands MW, Daniels SR, et al.: Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006, 47:296–308.
Institute of Medicine: Dietary Reference Intakes: Water, Potassium, Sodium Chloride, and Sulfate. Washington, DC: National Academy Press; 2004.
INTERSALT Cooperative Research Group: INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium excretion. BMJ 1988, 297:319–328.
Law MR, Frost CD, Wald NJ: By how much does dietary salt reduction lower blood pressure? III—Analysis of data from trials of salt reduction. BMJ 1991, 302:819–824.
He FJ, MacGregor GA: How far should salt intake be reduced? Hypertension 2003, 42:1093–1099. The best meta-analysis to date on salt intake—should be read by all who are skeptical of the role of salt.
Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med 2001, 344:3–10. The original DASH findings.
Lind L, Lithell H, Gustafsson IB, et al.: Calcium metabolism and sodium sensitivity in hypertensive subjects. J Hum Hypertens 1993, 7:53–57.
Ascherio A, Rimm EB, Hernan MA, et al.: Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998, 98:1198–1204.
Verhaar MC, Stroes E, Rabelink TJ: Folates and cardiovascular disease. Arterioscler Thromb Vasc Biol 2002, 22:6–13.
Rathaus M, Bernheim J: Oxygen species in the microvascular environment: regulation of vascular tone and the development of hypertension. Nephrol Dial Transplant 2002, 17:216–221.
O’Shaughnessy KM, Karet FE: Salt handling and hypertension. J Clin Invest 2004, 113:1075–1081.
Weir MR, Chrysant SG, McCarron DA, et al.: Influence of race and dietary salt on the antihypertensive efficacy of an angiotensin-converting enzyme inhibitor or a calcium channel antagonist in salt-sensitive hypertensives. Hypertension 1998, 31:1088–1096.
Whelton PK, He J, Cutler JA, et al.: Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997, 277:1624–1632.
Siani A, Strazzullo P, Russo L, et al.: Controlled trial of long-term oral potassium supplements in patients with mild hypertension. Br Med J (Clin Res Ed) 1987, 294:1453–1456.
Naismith DJ, Braschi A: The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Br J Nutr 2003, 90:53–60.
Berger K, Ajani UA, Kase CS, et al.: Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. N Engl J Med 1999, 341:1557–1564.
Klatsky MD: Alcohol, coronary disease and hypertension. Ann Rev Med 1996, 47:149–160.
Rimm EB, Williams P, Fosher K, et al.: Moderate alcohol intake and lower risk of coronary heart disease: metaanalysis of effects on lipids and haemostatic factors. BMJ 1999, 319:1523–1528.
Mukamal KJ, Conigrave KM, Mittleman MA, et al.: Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med 2003, 348:109–118.
Gaziano JM, Buring JE, Breslow JL, et al.: Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med 1993, 329:1829–1834.
Xin X, He J, Frontini MG, et al.: Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2001, 38:1112–1117.
Marmot MG, Elliott P, Shipley MJ, et al.: Alcohol and blood pressure: the INTERSALT study. BMJ 1994, 308:1263–1267.
MacMahon S, Cutler J, Brittain E, Higgins M: Obesity and hypertension: epidemiological and clinical issues. Eur Heart J 1987, 8(Suppl B):57–70.
Aucott L, Poobalan A, Smith WC, et al.: Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension 2005, 45:1035–1041.
He J, Whelton PK, Appel LJ, et al.: Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000, 35:544–549.
Sacks FM, Kass EH: Low blood pressure in vegetarians: effects of specific foods and nutrients. Am J Clin Nutr 1988, 48:795–800.
Van Gaal LF, Rissanen AM, Scheen AJ, et al.: Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2006, 365:1389–1397.
Geleijnse JM, Giltay EJ, Grobbee DE, et al.: Blood pressure response to fish oil supplementation: meta-regression analysis of randomized trials. J Hypertens 2002, 20:1493–1499.
Appel LJ, Miller ER III, Seidler AJ, Whelton PK: Does supplementation of diet with ‘fish oil’ reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med 1993, 153:1429–1438.
Dehmer GJ, Popma JJ, van den Berg EK, et al.: Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Engl J Med 1988, 319:733–740.
Ascherio A, Rimm EB, Stampfer MJ, et al.: Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among Men. N Engl J Med 1995, 332:977–983.
Neri LC, Johansen HL: Water hardness and cardiovascular mortality. Ann N Y Acad Sci 1978, 304:203–221.
Cappuccio FP, Elliott P, Allender PS, et al.: Epidemiologic association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol 1995, 142:935–945.
Appel LJ: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. J Am Med Assoc 2003, 289:2083–2093.
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O’Shaughnessy, K.M. Role of diet in hypertension management. Current Science Inc 8, 292–297 (2006). https://doi.org/10.1007/s11906-006-0067-y
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DOI: https://doi.org/10.1007/s11906-006-0067-y